Generic drug prices and policy in Australia: room for improvement? A comparative analysis with England

To assess the degree to which reimbursement prices in Australia and England differ for a range of generic drugs, and to analyse the supply- and demand-side factors that may contribute to these differences.

The evolution of clinical audit as a tool for quality improvement.

Clinical auditing practices are recognized universally as a useful tool in evaluating and improving the quality of care provided by a health service. External auditing is a regular activity for mental health services in Australia but internal auditing activities are conducted at the discretion of each service. This paper evaluates the effectiveness of 6 years of internal auditing activities in a mental health service. A review of the scope, audit tools, purpose, sampling and design of the internal audits and identification of the recommendations from six consecutive annual audit reports was completed. Audit recommendations were examined, as well as levels of implementation and reasons for success or failure. Fifty-seven recommendations were identified, with 35% without action, 28% implemented and 33.3% still pending or in progress. The recommendations were more likely to be implemented if they relied on activity, planning and action across a selection of service areas rather than being restricted to individual departments within a service, if they did not involve non-mental health service departments and if they were not reliant on attitudinal change. Tools used, scope and reporting formats have become more sophisticated as part of the evolutionary nature of the auditing process. Internal auditing in the Barwon Health Mental Health Service has been effective in producing change in the quality of care across the organization. A number of evolutionary changes in the audit process have improved the efficiency and effectiveness of the audit.

Improvement of the biomedical properties of titanium using SMAT and thermal oxidation

Titanium and its alloys are excellent candidates for biomedical implant. However, they exhibit relatively poor tribological properties. In this study, a two-step treatment including surface mechanical attrition treatment (SMAT) combined with thermal oxidation process has been developed to improve the tribological properties and biocompatibility of Ti. Ti after two-step treatment shows excellent wear-resistance and biocompatibility among all Ti samples, which can be ascribed to the highest surface energy, well crystallinity of rutile layer on its surface. Overall, the two-step treatment is a prospective method to produce excellent biomedical Ti materials.

Improvement of light harvesting and device performance of dye-sensitized solar cells using rod-like nanocrystal TiO2 overlay coating on TiO2 nanoparticle working electrode

Novel TiO2 single crystalline nanorods were synthesized by electrospinning and hydrothermal treatment. The role of the TiO2 nanorods on TiO2 nanoparticle electrode in improvement of light harvesting and photovoltaic properties of dye-sensitized solar cells (DSSCs) was examined. Although the TiO2 nanorods had lower dye loading than TiO2 nanoparticle, they showed higher light utilization behaviour. Electron transfer in TiO2 nanorods received less resistance than that in TiO2 nanoparticle aggregation. By just applying a thin layer of TiO2 nanorods on TiO2 nanoparticle working electrode, the DSSC device light harvesting ability and energy conversion efficiency were improved significantly. The thickness of the nanorod layer in the working electrode played an important role in determining the photovoltaic property of DSSCs. An energy conversion efficiency as high as 6.6% was found on a DSSC device with the working electrode consisting of a 12 μm think TiO2 nanoparticle layer covered with 3 μm thick TiO2 nanorods. The results obtained from this study may benefit further design of highly efficient DSSCs.

Using the Safe Schools Hub as a Tool for School Improvement

The Safe Schools Hub is an online portal created by the Australian Government to support the National Safe Schools Framework. The Hub contains an extensive collection of resources for leaders, teachers, specialist staff, parents and students. This interactive workshop will explore a variety of ways in which school leaders and teachers can use selected resources from the Hub to facilitate positive school change in areas such as student wellbeing, teacher wellbeing, student safety and parent engagement. These resources include practical activities that can be used in staff meetings, the use of Appreciative Inquiry, a whole-school audit tool and parent surveys.

Interprofessional interactions influence nurses' adoption of handover improvement

Aim: The purpose of this study was to explore clinician experiences of adopting quality improvement tools to standardise interprofessional (anaesthetist-to-nurse) handover communication when patients arrive in the post-anaesthetic care unit (PACU). Method: In this study, factors that impacted PACU nurses' adoption of the quality improvement tools were explored using pre- and postimplementation, semi-structured focus group interviews. Interview data was analysed using the PARiHS¹ (context, evidence and facilitation) framework as a deductive analysis tool. Results: PACU nurses recognised that PACU handover from anaesthetists to PACU nurses was suboptimal and described the tools as useful for their practice. However, PACU nurses frequently cited fear of anaesthetists' reactions as reasons not to insist on the use of the handover improvement tools. PACU nurses at Hospital 2 identified lacking "authority" (Hospital 2 FG 2) in the OR as hindering their willingness to use the tools against these behaviours. In comparison, visible support from leadership at Hospital 1 was described as encouraging nurses to be "assertive" (Hospital 1 FG 2) and take charge of their patients' care. Conclusion: PACU nurses perceived the handover tools were useful and helped them identify gaps in handover practice; however, PACU nurses described difficult relationships as hindering communication effectiveness and discouraging their adoption of the tools. However, strong leadership and organisational support of change emerged as essential to mitigate the effects of these difficult relationships.

Nerve guidance conduits from aligned nanofibers: improvement of nerve regeneration through longitudinal nanogrooves on a fiber surface

A novel fibrous conduit consisting of well-aligned nanofibers with longitudinal nanogrooves on the fiber surface was prepared by electrospinning and was subjected to an in vivo nerve regeneration study on rats using a sciatic nerve injury model. For comparison, a fibrous conduit having a similar fiber alignment structure without surface groove and an autograft were also conducted in the same test. The electrophysiological, walking track, gastrocnemius muscle, triple-immunofluorescence, and immunohistological analyses indicated that grooved fibers effectively improved sciatic nerve regeneration. This is mainly attributed to the highly ordered secondary structure formed by surface grooves and an increase in the specific surface area. Fibrous conduits made of longitudinally aligned nanofibers with longitudinal nanogrooves on the fiber surface may offer a new nerve guidance conduit for peripheral nerve repair and regeneration.

Improvement of charge/discharge properties of oligoether electrolytes by zwitterions with an attached cyano group for use in lithium-ion secondary batteries

Zwitterions with a cyano group on the side chain (CZ) were synthesized. Although the addition of CZ caused a slightly negative effect on viscosity, ionic conductivity, limiting current density, and lithium transference number, the oxidation limit of PEGDME/lithium bis(trifluoromethylsulfonyl)amide (LiTFSA) composites was improved to over 5 V. For charge/discharge testing using Li|electrolyte|LiCoO2 cells, the cycle stability of PEGDME/LiTFSA with CZ in the voltage range of 3.0-4.6 V was much higher than that of PEGDME/LiTFSA. Incorporating a small mole fraction of CZ into PEGDME-based electrolytes prevented an increase in the interface resistance between the electrolyte and cathode with increasing numbers of the cycle.

Simultaneous improvement in the strength and corrosion resistance of Al via high-energy ball milling and Cr alloying

The corrosion resistance and mechanical properties of nanocrystalline aluminium (Al) and Al-20. wt.%Cr alloys, synthesized by high-energy ball milling followed by spark plasma sintering, were investigated. Both alloys exhibited an excellent combination of corrosion resistance and compressive yield strength, which was attributed to the nanocrystalline structure, extended solubility, uniformly distributed fine particles, and homogenous microstructure induced by high-energy ball milling. This work demonstrates the possibilities of developing ultra-high strength Al alloys with excellent corrosion resistance, exploiting conventionally insoluble elements or alloying additions via suitable processing routes.

Vehicle motion simulators, a key step towards road vehicle dynamics improvement

Real road vehicle tests are time consuming, laborious, and costly, and involve several safety concerns. Road vehicle motion simulators (RVMS) could assist with vehicle testing, and eliminate or reduce the difficulties traditionally associated with conducting vehicle tests. However, such simulators must exhibit a high level of fidelity and accuracy in order to provide realistic and reliable outcomes. In this paper, we review existing RVMS and discuss each of the major RVMS subsystems related to the research and development of vehicle dynamics. The possibility of utilising motion simulators to conduct ride and handling test scenarios is also investigated.

Health improvement and prevention study (HIPS) - evaluation of an intervention to prevent vascular disease in general practice

Background

The Health Improvement and Prevention Study (HIPS) study aims to evaluate the capacity of general practice to identify patients at high risk for developing vascular disease and to reduce their risk of vascular disease and diabetes through behavioural interventions delivered in general practice and by the local primary care organization.

Methods/Design

HIPS is a stratified randomized controlled trial involving 30 general practices in NSW, Australia. Practices are randomly allocated to an 'intervention' or 'control' group. General practitioners (GPs) and practice nurses (PNs) are offered training in lifestyle counselling and motivational interviewing as well as practice visits and patient educational resources. Patients enrolled in the trial present for a health check in which the GP and PN provide brief lifestyle counselling based on the 5As model (ask, assess, advise, assist, and arrange) and refer high risk patients to a diet education and physical activity program. The program consists of two individual visits with a dietician or exercise physiologist and four group sessions, after which patients are followed up by the GP or PN. In each practice 160 eligible patients aged between 40 and 64 years are invited to participate in the study, with the expectation that 40 will be eligible and willing to participate. Evaluation data collection consists of (1) a practice questionnaire, (2) GP and PN questionnaires to assess preventive care attitudes and practices, (3) patient questionnaire to assess self-reported lifestyle behaviours and readiness to change, (4) physical assessment including weight, height, body mass index (BMI), waist circumference and blood pressure, (5) a fasting blood test for glucose and lipids, (6) a clinical record audit, and (7) qualitative data collection. All measures are collected at baseline and 12 months except the patient questionnaire which is also collected at 6 months. Study outcomes before and after the intervention is compared between intervention and control groups after adjusting for baseline differences and clustering at the level of the practice.

Discussion

This study will provide evidence of the effectiveness of a primary care intervention to reduce the risk of cardiovascular disease and diabetes in general practice patients. It will inform current policies and programs designed to prevent these conditions in Australian primary health care.

Evaluation of the Counterweight Programme for obesity management in primary care: a starting point for continuous improvement

Background Evaluation for obesity management in primary care is limited, and successful outcomes are from intensive clinical trials in hospital settings.

Aim To determine to what extent measures of success seen in intensive clinical trials can be achieved in routine primary care. Primary outcome measures were weight change and percentage of patients achieving ≤5% loss at 12 and 24 months.

Design of study Prospective evaluation of a new continuous improvement model for weight management in primary care.

Setting Primary care, UK.

Method Primary care practice nurses from 65 UK general practices delivered interventions to 1906 patients with body mass index (BMI) ≥30 kg/m2 or ≥28 kg/m2 with obesity-related comorbidities.

Results Mean baseline weight was 101.2 kg (BMI 37.1 kg/m2); 25% of patients had BMI ≥40 kg/m2 and 74% had ≥1 major obesity-related comorbidity. At final data capture 1419 patients were in the programme for ≥12 months, and 825 for ≥24 months. Mean weight change in those who attended and had data at 12 months (n = 642) was −3.0 kg (95% CI = −3.5 to −2.4 kg) and at 24 months (n = 357) was −2.3 kg (95% CI = −3.2 to −1.4 kg). Among attenders at specific time-points, 30.7% had maintained weight loss of ≥5% at 12 months, and 31.9% at 24 months. A total of 761 (54%) of all 1419 patients who had been enrolled in the programme for >12 months provided data at or beyond 12 months.

Conclusion This intervention achieves and maintains clinically valuable weight loss within routine primary care.